w1 Flashcards
________ admission
- Both the individual and the health care professionals agree with the need for treatment and hospitalization
- Person signs a consent form
_________ admission
- Health care professionals feel admit is necessary, Person does not want to be admit
- Can be admit against their will under 72 hour hold (weekends and holidays don’t count)
- During the 72 hour hold the pt may become better with treatment and end up agreeing to treatment making them a voluntary admission
- If after 72 hour hold the pt still doesn’t want to be there but the health care professionals deem it necessary, the court system will be _________ for further care
Voluntary admission
- Both the individual and the health care professionals agree with the need for treatment and hospitalization
- Person signs a consent form
Involuntary admission/commitment
- Health care professionals feel admit is necessary, Person does not want to be admit
- Can be admit against their will under 72 hour hold (weekends and holidays don’t count)
- During the 72 hour hold the pt may become better with treatment and end up agreeing to treatment making them a voluntary admission
- If after 72 hour hold the pt still doesn’t want to be there but the health care professionals deem it necessary, the court system will be petitioned for further care
Inpatient admission criteria
- Danger to self ______ and/or ____
- Danger to others - _________
- Cant care for ______ and/or gross impairment of judgement, person is at risk r/t inability to protect themselves
Inpatient admission criteria
- Danger to self (SI) and/or SA
- Danger to others - homicidal ideations (HI)
- Cant care for basic needs and/or gross impairment of judgement, person is at risk r/t inability to protect themselves
2 co-occurring chronic illnesses (depression and anxiety, depression and diabetes)
co-occurring mental illness and substance use disorder (depression and alcohol)
- Comorbidity – 2 co-occurring chronic illnesses (depression and anxiety, depression and diabetes)
- Dual diagnosis – co-occurring mental illness and substance use disorder (depression and alcohol)
patient assessment
general risk identification includes assessing:
- history of violence – best predictor of future violence
- pts who are delusional, hyperactive, impulsive, irritable, or non-adherence to medication - higher risk for violence
- aggression by individuals occurs most often in the context of limit setting by the nurse – asking pt to do/not do something
- history of limited coping skills, lack of assertiveness, use of intimidation – higher risk for violence
- agitation, restlessness, escalating anxiety
- resistance to suggested treatment
- didn’t come willingly
- history of drug or alcohol misuse
- cognitive changes (delirium, psychosis, hallucinations, etc.) that may cause the person to misinterpret the environment or staff care activities
patient assessment
general risk identification includes assessing:
- history of violence – best predictor of future violence
- pts who are delusional, hyperactive, impulsive, irritable, or non-adherence to medication - higher risk for violence
- aggression by individuals occurs most often in the context of limit setting by the nurse – asking pt to do/not do something
- history of limited coping skills, lack of assertiveness, use of intimidation – higher risk for violence
- agitation, restlessness, escalating anxiety
- resistance to suggested treatment
- didn’t come willingly
- history of drug or alcohol misuse
- cognitive changes (delirium, psychosis, hallucinations, etc.) that may cause the person to misinterpret the environment or staff care activities
Rights of hospitalized patient
Right to:
- Receive/refuse ________
- Dignity
- Involvement in planning
- AMA
- Protection from _____
- Legal counsel
- Communication
- Confidentiality
- Least restrictive means
Rights of hospitalized patient
Right to:
- Receive/refuse treatment
- Dignity
- Involvement in planning
- AMA
- Protection from harm
- Legal counsel
- Communication
- Confidentiality
- Least restrictive means
social influences on mental health care
1- consumer movement/recovery
o consumers (groups of individuals with mental illness) began to advocate for their right and fought against discrimination and forced treatment
2- national alliance on mental illness (NAMI) – focuses on stigma
o communicating mental illness is a brain disorder
o eliminating stigma and discrimination
o advocating for people with mental illness
o improving access to treatment services
o integrating mental illness into community life
3- surgeon general report on mental health
o reports on seriousness of mental health and illness, treatment, etc.
4- new freedom commission on mental health
o streamlined system with less fragmentation in care
o advocated for early diagnosis and treatment
o adoption of principles of recovery
o increased assistance with housing/jobs
5- Fayette county mental health court
o Specialists help pts get housing and other services
o Team includes judges, prosecutors, providers, case workers
o Care is person centered
o Goal to reduce reoffending – keep pt out of jail
o Strict criteria to be eligible
o Treatment/medication may be alternative for some instead of jail term
social influences on mental health care
- consumer movement/recovery
o consumers (groups of individuals with mental illness) began to advocate for their right and fought against discrimination and forced treatment
- national alliance on mental illness (NAMI) – focuses on stigma
o communicating mental illness is a brain disorder
o eliminating stigma and discrimination
o advocating for people with mental illness
o improving access to treatment services
o integrating mental illness into community life
- surgeon general report on mental health
o reports on seriousness of mental health and illness, treatment, etc.
- new freedom commission on mental health
o streamlined system with less fragmentation in care
o advocated for early diagnosis and treatment
o adoption of principles of recovery
o increased assistance with housing/jobs
- Fayette county mental health court
o Specialists help pts get housing and other services
o Team includes judges, prosecutors, providers, case workers
o Care is person centered
o Goal to reduce reoffending – keep pt out of jail
o Strict criteria to be eligible
o Treatment/medication may be alternative for some instead of jail term
Patients rights under the law
Right to:
- Receive/refuse treatment
- Informed consent
o Risk, benefits, alternatives
o voluntarily accept treatment
o implied consent
o capacity and competency
- psychiatric advance directives
- restraints and seclusion
o orders and documentation required
o in an emergency, nurse may place pt in seclusion or restraint but obtains an order ASAP
o orders for restraint or seclusion are never written as PRN
- confidentiality
o HIPAA, Social media, After death, Professional communications
- Exceptions to rule
o Duty to warm and protect third parties
o Child and elder abuse reporting statutes
- Failure to protect patients
Patients rights under the law
Right to:
- Receive/refuse treatment
- Informed consent
o Risk, benefits, alternatives
o voluntarily accept treatment
o implied consent
o capacity and competency
- psychiatric advance directives
- restraints and seclusion
o orders and documentation required
o in an emergency, nurse may place pt in seclusion or restraint but obtains an order ASAP
o orders for restraint or seclusion are never written as PRN
- confidentiality
o HIPAA
o Social media
o After death
o Professional communications
- Exceptions to rule
o Duty to warm and protect third parties
o Child and elder abuse reporting statutes
- Failure to protect patients
therapeutic _______
- provides sense of security/safety
- interactions with peers and staff help the pt engage and increase social competence and self worth
- real life training ground for practicing communication and coping skills
- provides activities, unit rules, reality orientation practices and groups
therapeutic milieu
- provides sense of security/safety
- interactions with peers and staff help the pt engage and increase social competence and self worth
- real life training ground for practicing communication and coping skills
- provides activities, unit rules, reality orientation practices and groups
Warning signs of violence:
- ____________ (most important predictor) – pacing, restlessness
- increasing anxiety and tension – clenched jaw or fist, rigid posture, fixed or tensed facial expression, mumbling to self
- speech changes – rate, rhythm or volume, or silence
- verbal abuse – profanity, argumentativeness
- intense eye contact or avoidance of eye contact
- recent acts of violence
- possession of a weapon
- isolation that is uncharacteristic
Warning signs of violence:
- hyperactivity (most important predictor) – pacing, restlessness
- increasing anxiety and tension – clenched jaw or fist, rigid posture, fixed or tensed facial expression, mumbling to self
- speech changes – rate, rhythm or volume, or silence
- verbal abuse – profanity, argumentativeness
- intense eye contact or avoidance of eye contact
- recent acts of violence
- possession of a weapon
- isolation that is uncharacteristic
___________
Step below PHP
Structured activities and group 1-2 days a week for 4 weeks or less
Goals: improve coping, enhance strengths for more functional independent life, build social skills and relationships
____________
- Highly structured
- Optimizes safety and crisis intervention
- Average length of stay = 3-7 days
___________
For pts needing longer than 7 days to stabilize illness/symptoms
______________
For pts that need some supervision but are not appropriate for inpatient hospitalization
Step between inpatient and fully independent home life
Ex: Goes to hospital for 6 hours for group therapy every day and then goes home every night
Goals: safety, reduce hospital admit, assist with coping
- Day treatment –
Step below PHP
Structured activities and group 1-2 days a week for 4 weeks or less
Goals: improve coping, enhance strengths for more functional independent life, build social skills and relationships
Acute care hospital
- Highly structured
- Optimizes safety and crisis intervention
- Average length of stay = 3-7 days
Long term hospitalization - For pts needing longer than 7 days to stabilize illness/symptoms
- Partial hospitalization programs
For pts that need some supervision but are not appropriate for inpatient hospitalization
Step between inpatient and fully independent home life
Ex: Goes to hospital for 6 hours for group therapy every day and then goes home every night
Goals: safety, reduce hospital admit, assist with coping
__________
An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual
Violence
An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual
legislation that resulted in the mass movement of severely mentally ill persons from state hospitals to outpatient care
- Deinstitutionalization - legislation that resulted in the mass movement of severely mentally ill persons from state hospitals to outpatient care
____________- Neurological process that removes unnecessary/damaged neuronal structures
- Improves networking capacity
- weeding out the weaker synpases
- As the brain develops, simple synapses are replaced by complex synapses
- Number of Adult neurons are ________ than newborns d/t synapses pruning
- Ongoing process
- _______pruning = schizophrenia, hallucinations
Synaptic pruning - Neurological process that removes unnecessary/damaged neuronal structures
- Improves networking capacity
- Pruning = weeding out the weaker synpases
- As the brain develops, simple synapses are replaced by complex synapses
- Number of Adult neurons are lower than newborns d/t synapses pruning
- Ongoing process
- Overpruning = schizophrenia, hallucinations
the brain and emotions
___________– relays information between the 2 cerebral hemispheres
- if damaged – people cant integrate emotions and logical information
- if left brain (_______ side) is dominant = less ability to feel emotion
- if right brain (__________ side) is dominant = difficult to control emotions and problem solve, loss of object constancy
the brain and emotions
corpus callosum – relays information between the 2 cerebral hemispheres
- if damaged – people cant integrate emotions and logical information
- if left brain (logical side) is dominant = less ability to feel emotion
- if right brain (emotional side) is dominant = difficult to control emotions and problem solve, loss of object constancy
GABA: inhibitory/calming
- Major inhibitory mechanism
- Reduces anxiety, aggression, and stress
- Regulates no repinephrine, adrenaline, dopamine, and serotonin
__creased GABA = anxiety, mania, and schizophrenia
GABA: inhibitory/calming
- Major inhibitory mechanism
- Reduces anxiety, aggression, and stress
- Regulates no repinephrine, adrenaline, dopamine, and serotonin
Decreased GABA = anxiety, mania, and schizophrenia
contraindications fro seclusion and restraints
- unstable medical and psychiatric conditions
- COPD
- Spinal injury
- Seizure
- Pregnancy
- Delirium or dementia
contraindications
- unstable medical and psychiatric conditions
- COPD
- Spinal injury
- Seizure
- Pregnancy
- Delirium or dementia
de-escalation techniques
- early response
- assess pt and situation
- identify stressors
- identify pt needs
- stay calm
- use calm clear tone of voice
- be genuine and empathetic
- be assertive – not aggressive
- avoid arguing
- give several clear options
- invest time
- be honest
- maintain pt self-esteem and dignity
- avoid invading personal space
- maintain personal safety
de-escalation techniques
- early response
- assess pt and situation
- identify stressors
- identify pt needs
- stay calm
- use calm clear tone of voice
- be genuine and empathetic
- be assertive – not aggressive
- avoid arguing
- give several clear options
- invest time
- be honest
- maintain pt self-esteem and dignity
- avoid invading personal space
- maintain personal safety
Tim’s Law
Assisted _________ treatment statute
- Named after a Lexington man with schizophrenia with __________ (person doesn’t believe they have a mental illness)
- Helps to stop the revolving door of jails, hospitals, and homelessness
Tim’s Law
Assisted outpatient treatment statute
- Named after a Lexington man with schizophrenia with anosognosia (person doesn’t believe they have a mental illness)
- Helps to stop the revolving door of jails, hospitals, and homelessness
least restrictive means of treatment
when the pt appears agitated the health care professional will:
- ______ the pt to see whats wrong
- encourage the pt to go to room for decreased _________
- offer PRN meds (route ____)
- escort to ______ area
- admin PRN meds (route ____)
- use _______ only if pt is a danger to self or others
least restrictive means of treatment
when the pt appears agitated the health care professional will:
- assess the pt to see whats wrong
- encourage the pt to go to room for decreased stimulation
- offer PRN meds PO
- escort to seclusion area
- admin PRN meds IM
- use restraints only if pt is a danger to self or others
____________
An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual
__________
an action or behavior that results in a verbal or physical attack
______________
Normal emotional response to frustration of desires, a threat to someones needs, or a challenge that varies in intensity from mild irritation to intense fury/rage
Violence
An objectionable act that involves intentional use of force that results in or has the potential to result in injury to another individual
aggression
an action or behavior that results in a verbal or physical attack
Anger
Normal emotional response to frustration of desires, a threat to someones needs, or a challenge that varies in intensity from mild irritation to intense fury/rage
revolving door treatment - cycle of repeated hospitalizations and discharges for individuals with severe mental illness
began in 1960’s with community mental health movement and ____________
- psychotropic drug development
- pts were deinstitutionalization to communities lacking in services
- patients were without _____ to function independently in a community
- pts returned to ED for care and repeated admissions to psychiatric inpatient units
Managed care company’s strategies (may contribute to revolving door treatment):
- ________ inpatient length of stay
- applying stringent ________ criteria
- limited community support
revolving door treatment
cycle of repeated hospitalizations and discharges for individuals with severe mental illness
began in 1960’s with community mental health movement and deinstitutionalization
- psychotropic drug development
- pts were deinstitutionalization to communities lacking in services
- patients were without skills to function independently in a community
- pts returned to ED for care and repeated admissions to psychiatric inpatient units
Managed care company’s strategies (may contribute to revolving door treatment):
- reducing inpatient length of stay
- applying stringent admission criteria
- limited community support
patient behavior: _______________
when angry expression turns to hostility and abuse or aggression (any activity that is meant to cause physical harm)
- may begin as accusations, comments about competence, and irrelevant personal remarks
danger signs:
- persistent swearing
- sexist or racist comments
- personal or specific threats of harm
- intimidating comments
- terroristic threats
- any physical behavior directed at a person
nurse response
- call for help
- protect self
- verbal intervention
o control non verbal communication
o short sentences
o don’t agree just to agree
o explain aggression will not achieve desired goal – if person is still rational
patient intimidation/acting out
when angry expression turns to hostility and abuse or aggression (any activity that is meant to cause physical harm)
- may begin as accusations, comments about competence, and irrelevant personal remarks
danger signs:
- persistent swearing
- sexist or racist comments
- personal or specific threats of harm
- intimidating comments
- terroristic threats
- any physical behavior directed at a person
nurse response
- call for help
- protect self
- verbal intervention
o control non verbal communication
o short sentences
o don’t agree just to agree
o explain aggression will not achieve desired goal – if person is still rational
surroundings and physical enviro of the inpatient hospital unit
milieu
_________
Normal emotional response to frustration of desires, a threat to someones needs, or a challenge that varies in intensity from mild irritation to intense fury/rage
- Normal human emotion
- when handled appropriately and expressed assertively, can provide individual with a positive force to solve problems and make decisions concerning life situations
- is only a problem when it is not handle appropriately and it is expressed aggressively
- is capable of being under personal control
Anger
Normal emotional response to frustration of desires, a threat to someones needs, or a challenge that varies in intensity from mild irritation to intense fury/rage
- Normal human emotion
- when handled appropriately and expressed assertively, can provide individual with a positive force to solve problems and make decisions concerning life situations
- anger = problem when it is not handle appropriately and it is expressed aggressively
- anger is capable of being under personal control
early treatments
- s/s were believed to be behavioral (under persons control)
- abnormal behaviors could be adjusted by:
o restraining devices – padded helmets, hand mittens, chemical restraints, straight jacket
o surgery – lobotomy, insulin therapy, hydrotherapy, sedative cold wet packs, electro-shock therapy
early treatments
- s/s were believed to be behavioral (under persons control)
- abnormal behaviors could be adjusted by:
o restraining devices – padded helmets, hand mittens, chemical restraints, straight jacket
o surgery – lobotomy, insulin therapy, hydrotherapy, sedative cold wet packs, electro-shock therapy
state of well being in which everyone can realize their own potential, cope with stresses, work productively, and contribute to the community
- Mental heath – state of well being in which everyone can realize their own potential, cope with stresses, work productively, and contribute to the community
limbic system: ___________
- memory
- controls the endocrine and immune systems
limbic system: __________
- processes emotions – anxiety, fear, and pleasure
- damage in animals = rage
____________
- coordinates and aids in moving skeletal muscles
limbic system: hippocampus
- memory
- controls the endocrine and immune systems
limbic system: amygdala
- processes emotions – anxiety, fear, and pleasure
- damage amygdala in animals = rage
basal ganglia
- coordinates and aids in moving skeletal muscles
ability and capacity to secure resources needed to support well-being
characterized by
- optimism
- sense of mastery
- competence
essential to recovery
- Resilience - ability and capacity to secure resources needed to support well-being
patient behavior: _______________
loss of rationality
- pt asking challenging questions
- pt in your personal space
- refusing!! your requests
- releasing!! – throwing things (not at you), banging fists, sighing loudly
nurse response
- isolate the interaction – move the pt, others, allow yourself and exit
- reduce enviro stimulation
- speak clear, slow, few words
- non-verbal communication
- firm, empathy
- allow releasing as long as its not threatening
patient defensiveness
loss of rationality
- pt asking challenging questions
- pt in your personal space
- refusing your requests
- releasing – throwing things (not at you), banging fists, sighing loudly
nurse response
- isolate the interaction – move the pt, others, allow yourself and exit
- reduce enviro stimulation
- speak clear, slow, few words
- non-verbal communication
- firm, empathy
- allow releasing as long as its not threatening
seclusion and restraint
- last resort
- pt is danger to self or others
- less restrictive interventions have been ineffective
- modification to care plan
- safe and appropriate techniques used
seclusion and restraint
- last resort
- pt is danger to self or others
- less restrictive interventions have been ineffective
- modification to care plan
- safe and appropriate techniques used
neurotransmitters
____________
- Cognitive function – learning, memory
- Sleep wake cycles
Acetylcholine
- Cognitive function – learning, memory
- Sleep wake cycles
Decreased acetylcholine = Alzheimer’s and sleep disorders
Increased acetylcholine = depression
deinstitutionalization - legislation that resulted in the mass movement of severely mentally ill persons from state hospitals to outpatient care
- many hospitals ______ as a result
- many patients successfully transitioned into _________ with the use of new psychotropic medications
- many ended up in _______
o most don’t receive treatment for mental illness in jail
o high risk of being ________ - verbal or physical abuse, bullying, threats, theft, rape, exploitation by partners, families, healthcare providers, or inpatient staff
o once released most don’t have healthcare
o criminal records make it hard to find jobs/housing
o many end up homeless, in ED, or re-arrested
deinstitutionalization
legislation that resulted in the mass movement of severely mentally ill persons from state hospitals to outpatient care
- many hospitals closed as a result
- patients successfully transitioned into the community with the use of new psychotropic medications
- many ended up in jail/prison
o most don’t receive treatment for mental illness in jail
o high risk of being victimized - verbal or physical abuse, bullying, threats, theft, rape, exploitation by partners, families, healthcare providers, or inpatient staff
o once released most don’t have healthcare
o criminal records make it hard to find jobs/housing
o many end up homeless, in ED, or re-arrested
early theories of mental illness
- inheritance theory – transmitted through generations
- moral degeneracy theory – mentally ill by virtue of bad character
- germ theory – insanity is contagious and needs to be segregated
- septic foci theory – insanity is an infection and removing the infection by surgery would be a cure (bleeding or leeches possible treatments)
early theories of mental illness
- inheritance theory – transmitted through generations
- moral degeneracy theory – mentally ill by virtue of bad character
- germ theory – insanity is contagious and needs to be segregated
- septic foci theory – insanity is an infection and removing the infection by surgery would be a cure (bleeding or leeches possible treatments)
T/F
- Learning, memory, and perception are influenced by past experiences and the ability of the brain to organize information
- Faulty neurotransmitter connections and brain lobe deficits may result in psychiatric symptoms
- Factors that negatively impact the brain can’t be changed
- The brain can’t change or heal
- Synapses pruning is the neurological process which removes unnecessary or damaged neuronal structures form the brain
- A person can develop healthy ways to deal with stress
T - Learning, memory, and perception are influenced by past experiences and the ability of the brain to organize information
T - Faulty neurotransmitter connections and brain lobe deficits may result in psychiatric symptoms
F - Factors that negatively impact the brain can be changed
F - The brain can change and heal with neuroplasticity
T - Synapses pruning is the neurological process which removes unnecessary or damaged neuronal structures form the brain
T - A person can develop healthy ways to deal with stress
Nursing interventions and education for healthy brains
- Social connections – provide community resources
- New learning
- Healthy diet
- Sleep hygiene (low blood flow to brain, crave sugar = low sleep)
- Exercise
- Healthy anxiety
- Meditation (activates frontal lobe)
- Gratitude
- Atop ANT (automatic negative thoughts to combat cognitive distortions/negative thinking
- Stress reduction – decrease cortisol levels which positively impact the parasympathetic nervous system, decreases BP, decreases infection rates, and decreases weight gain
o Relaxation therapy
o Meditation
o Deep breathing
o Anything that decreases the stress response and regulates the body’s system
Nursing interventions and education for healthy brains
- Social connections – provide community resources
- New learning
- Healthy diet
- Sleep hygiene (low blood flow to brain, crave sugar = low sleep)
- Exercise
- Healthy anxiety
- Meditation (activates frontal lobe)
- Gratitude
- Atop ANT (automatic negative thoughts to combat cognitive distortions/negative thinking
- Stress reduction – decrease cortisol levels which positively impact the parasympathetic nervous system, decreases BP, decreases infection rates, and decreases weight gain
o Relaxation therapy
o Meditation
o Deep breathing
o Anything that decreases the stress response and regulates the body’s system
___________
an action or behavior that results in a verbal or physical attack
- tends to be used with violence
- behavior is intended to threaten or injure the victims security or self esteem
- can cause damage with words or strikes to body (fists, kicks, weapons) but it always is designed to punish
- not always inappropriate, sometimes necessary for self-protection
aggression
an action or behavior that results in a verbal or physical attack
- tends to be used with violence
- behavior is intended to threaten or injure the victims security or self esteem
- can cause damage with words or strikes to body (fists, kicks, weapons) but it always is designed to punish
- not always inappropriate, sometimes necessary for self-protection
cycle of repeated hospitalizations and discharges for individuals with severe mental illness
- Revolving door treatment - cycle of repeated hospitalizations and discharges for individuals with severe mental illness
_______________
Immediate and mandatory debriefing for staff and pt who took part/witnessed the seclusion/restraint episode
Components
- Improvements
- Team response
- Safety
- Policies
- Procedure
- Pt dignity
- Staff education
Critical incident debriefing
Immediate and mandatory debriefing for staff and pt who took part/witnessed the seclusion/restraint episode
Components
- Improvements
- Team response
- Safety
- Policies
- Procedure
- Pt dignity
- Staff education
Factors that hurt the brain
- Unhealthy habits
- Lack of interest
- Obesity
- Negative thinking/thought distortions
- Sedentary lifestyle
- Substance use
- Brain injury
- Enviro toxins
- Phobia, unfound worry
- Anxiety
- HTN
- Lack of appreciation
- Insomnia
Factors that hurt the brain
- Unhealthy habits
- Lack of interest
- Obesity
- Negative thinking/thought distortions
- Sedentary lifestyle
- Substance use
- Brain injury
- Enviro toxins
- Phobia, unfound worry
- Anxiety
- HTN
- Lack of appreciation
- Insomnia
neurotransmitter
_______________
- Pleasure feelings
- Complex motor activities
- Plays role in hallucinations
Dopamine: excitatory
- Pleasure feelings
- Complex motor activites
- Plays role in hallucinations
Decreased dopamine = depression and addiction
Increased dopamine = mania and symptoms in schizophrenia
health conditions involving changes in emotion, thinking or behavior (or a combination of these). Associated with distress and/or problems functioning in social, work or family activities.
- Mental illness – health conditions involving changes in emotion, thinking or behavior (or a combination of these). Associated with distress and/or problems functioning in social, work or family activities.
neurotransmitter
______________
- Mood
- Attention
- Arousal
- Stimulates sympathetic branch of autonomic nervous system for fight or flight stress response
Norepinephrine
- Mood
- Attention
- Arousal
- Stimulates sympathetic branch of autonomic nervous system for fight or flight stress response
Decreased norepinephrine = depression
Increased norepinephrine = mania, anxiety, schizophrenia
__________ – involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving
- never punitive
- goal – safety for pt and others
- only used for the management of violent or self-destructive behavior that puts others safety at risk
seclusion – involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving
- never punitive
- goal – safety for pt and others
- only used for the management of violent or self-destructive behavior that puts others safety at risk
combination of genetic vulnerability and negative environmental stressors
- Diathesis-stress model - combination of genetic vulnerability and negative environmental stressors
diathesis = biological predisposition
stress = environmental stress/trauma
diathesis stress model = combination of genetic vulnerability and negative environmental stressors
- most accepted explanation for mental illness
- most psych disorders result from a combo of genetic vulnerability and negative enviro stressor
_________ – manual method, physical or mechanical devise, material/equipment that immobilized or reduces the ability of a patient to move body freely
- never restrain in prone position
- increased danger in child restraint
restraint – manual method, physical or mechanical devise, material/equipment that immobilized or reduces the ability of a patient to move body freely
- never restrain in prone position
- increased danger in child restraint
Neurotransmitters
______________
- Major inhibitory mechanism
- Reduces anxiety, aggression, and stress
- Regulates no repinephrine, adrenaline, dopamine, and serotonin
GABA: inhibitory/calming
- Major inhibitory mechanism
- Reduces anxiety, aggression, and stress
- Regulates no repinephrine, adrenaline, dopamine, and serotonin
Decreased GABA = anxiety, mania, and schizophrenia
serotonin: inhibitory/calming
- Mood
- Emotion
- Sleep
- Pain
- Appetite
- Temperature regulation
- Some cognitive function
___creased serotonin = depressive and anxiety disorders
serotonin: inhibitory/calming
- Mood
- Emotion
- Sleep
- Pain
- Appetite
- Temperature regulation
- Some cognitive function
Decreased serotonin = depressive and anxiety disorders
__________- the quantitative study of the distribution of mental disorders in human populations.
Epidemiology - the quantitative study of the distribution of mental disorders in human populations.
Barriers to the delivery of adequate and accessible mental healthcare
- ___creasing need for mental health care
- Limited access to mental health services
o Transportation
o Long waits for appointments
o Income/cost
o Insurance
- Provider limitations
- Stigma
o Fear and misunderstanding
o Film and literature
Barriers to the delivery of adequate and accessible mental healthcare
- Increasing need for mental health care
- Limited access to mental health services
o Transportation
o Long waits for appointments
o Income/cost
o Insurance
- Provider limitations
- Stigma
o Fear and misunderstanding
o Film and literature
feelings that may precipitate anger:
- anxiety
- discounted
- embarrassed
- frightened
- fear
- humiliated
- hurt
- ignored
- inadequate
- insecure
- unheard
- out of control of the situation
- rejected
- threatened
- tired
- vulnerable
feelings that may precipitate anger:
- anxiety
- discounted
- embarrassed
- frightened
- fear
- humiliated
- hurt
- ignored
- inadequate
- insecure
- unheard
- out of control of the situation
- rejected
- threatened
- tired
- vulnerable
situations that may precipitate anger:
- withdrawal/substance abuse or addictions
- diagnosed by psychiatric illness
- internal stimuli – auditory hallucinations
- attention-seeking
- sleep deprivation
- pain
- stress
- past trauma
- loss of personal power
- difference in expectations or goals
- difference in knowledge
- poor communication
- inaccurate or incomplete information
- environment – too hot, too loud, etc.
situations that may precipitate anger:
- withdrawal/substance abuse or addictions
- diagnosed by psychiatric illness
- internal stimuli – auditory hallucinations
- attention-seeking
- sleep deprivation
- pain
- stress
- past trauma
- loss of personal power
- difference in expectations or goals
- difference in knowledge
- poor communication
- inaccurate or incomplete information
- environment – too hot, too loud, etc.
Visualizing the brain
Structured imaging techniques show _________ (ex: tumors, atrophy)
- CT
- MRI
Functional imaging techniques show brain _________ (physiological changes)
- PET
- Single photon emission computed tomography (SPECT)
- Functional MRI
Visualizing the brain
Structured imaging techniques show anatomy (ex: tumors, atrophy)
- CT
- MRI
Functional imaging techniques show brain function (physiological changes)
- PET
- Single photon emission computed tomography (SPECT)
- Functional MRI
Dopamine: excitatory
- Pleasure feelings
- Complex motor activites
- Plays role in hallucinations
___creased dopamine = depression and addiction
___creased dopamine = mania and symptoms in schizophrenia
Dopamine: excitatory
- Pleasure feelings
- Complex motor activites
- Plays role in hallucinations
Decreased dopamine = depression and addiction
Increased dopamine = mania and symptoms in schizophrenia
process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential
- Recovery – process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential
Acetylcholine
- Cognitive function – learning, memory
- Sleep wake cycles
__creased acetylcholine = Alzheimer’s and sleep disorders
__creased acetylcholine = depression
Acetylcholine
- Cognitive function – learning, memory
- Sleep wake cycles
Decreased acetylcholine = Alzheimer’s and sleep disorders
Increased acetylcholine = depression
_____________
decrease in energy, rationality returns, reachable teachable moments
staff interventions
- therapeutic rapport
- revise care plan
tension reduction
decrease in energy, rationality returns, reachable teachable moments
staff interventions
- therapeutic rapport
- revise care plan
_________ nervous system - sends signals
________ cortex – where touch sensation is evaluated
peripheral nervous system - sends signals
sensory cortex – touch sensation is evaluated in the sensory cortex
Norepinephrine
- Mood
- Attention
- Arousal
- Stimulates sympathetic branch of autonomic nervous system for fight or flight stress response
__creased norepinephrine = depression
__creased norepinephrine = mania, anxiety, schizophrenia
Norepinephrine
- Mood
- Attention
- Arousal
- Stimulates sympathetic branch of autonomic nervous system for fight or flight stress response
Decreased norepinephrine = depression
Increased norepinephrine = mania, anxiety, schizophrenia
following the plan of care developed as part of the health care team
- Adherence – following the plan of care developed as part of the health care team
Major brain functions
- Maintenance of homeostasis
- Regulation of _______ nervous system and hormones
- Controls biological drives and behavior
o Sleep and wake cycle
o Circadian rhythm
o Sex
- Conscious mental activity – thinking, problem solving
- Memory
- Social skills
Major brain functions
- Maintenance of homeostasis
- Regulation of autonomic nervous system (ANS) and hormones
- Controls biological drives and behavior
o Sleep and wake cycle
o Circadian rhythm
o Sex
- Conscious mental activity – thinking, problem solving
- Memory
- Social skills
__________- The lifelong ability of the brain to change with learning
- New pathways are laid down as we learn, experience, and acquire new knowledge and skills
- To learn or memorize a fact or skill = there must be a persistent functional change in the brain the represents the new knowledge
Neuroplasticity - The lifelong ability of the brain to change with learning
- New pathways are laid down as we learn, experience, and acquire new knowledge and skills
- To learn or memorize a fact or skill = there must be a persistent functional change in the brain the represents the new knowledge
milieu characteristics conducive to violence:
- environment – too hot, too loud, etc.
- overcrowding
- inexperienced staff
- controlling staff
- poor limit setting
- revocation of privileges
milieu characteristics conducive to violence:
- environment – too hot, too loud, etc.
- overcrowding
- inexperienced staff
- controlling staff
- poor limit setting
- revocation of privileges
interventions
- begin interventions prior to any signs of escalation
- non-threatening, non-directive interactions will help in developing a therapeutic relationship
- approach patient in a controlled, non-threatening, caring manner
- allow space (1 foot further than the patient can reach) – perceived as less of a threat
- ensure escape route
- do not take it personally or respond in kind if pt invades space or is verbally abusive
- speak slowly, short sentences, low and calm voice
- open ended statements and questions
- identify what is behind the angry feelings and behaviors
- encourage pt to assume responsibility for choices made
- talk to the pt in a quiet and visible place
- avoid medical jargon
pharmacological interventions
- PRN meds
- Long term treatment of A/A/V is based on treating the underlying psychiatric disorder
interventions
- begin interventions prior to any signs of escalation
- non-threatening, non-directive interactions will help in developing a therapeutic relationship
- approach patient in a controlled, non-threatening, caring manner
- allow space (1 foot further than the patient can reach) – perceived as less of a threat
- ensure escape route
- do not take it personally or respond in kind if pt invades space or is verbally abusive
- speak slowly, short sentences, low and calm voice
- open ended statements and questions
- identify what is behind the angry feelings and behaviors
- encourage pt to assume responsibility for choices made
- talk to the pt in a quiet and visible place
- avoid medical jargon
pharmacological interventions
- PRN meds
- Long term treatment of A/A/V is based on treating the underlying psychiatric disorder
neurotransmitters: inhibitory/calming
(2)
neurotransmitters: excitatory
(2)
neurotransmitters: other
(3)
- Dopamine
- Glutamate
- serotonin
- GABA
- Acetylcholine
- Histamine
- Norepinephrine
neurotransmitters: inhibitory/calming
- serotonin
- GABA
neurotransmitters: excitatory
- Dopamine
- Glutamate
neurotransmitters: other
- Acetylcholine
- Histamine
- Norepinephrine
part of brain
__________ – memory and emotions
- Is there an emotional connection of a pervious/similar touch experience?
- part of limbic system
- processes emotions – anxiety, fear, and pleasure
Amygdala – memory and emotions
- Is there an emotional connection of a pervious/similar touch experience?
- part of limbic system
- processes emotions – anxiety, fear, and pleasure
Glutamate: excitatory
__creased glutamate = seizure activity and neurodegeneration in Alzheimer’s
__creased glutamate = psychosis, autism, OCD, depression, and schizophrenia
Glutamate: excitatory
Increased glutamate = seizure activity and neurodegeneration in Alzheimer’s
Decreased glutamate = psychosis, autism, OCD, depression, and schizophrenia
____________
- Required insurance companies to provide equal treatment coverage for psychiatric disorders as other medical issues
__________
- Coverage for most uninsured American through expanded Medicaid eligibility
Mental health parity act
- Parity = equivalence
- Required insurance companies to provide equal treatment coverage for psychiatric disorders as other medical issues
Patient protection and affordable care act
- Coverage for most uninsured American through expanded Medicaid eligibility
what does ________ look like:
- irritability
- frowning or grimacing
- red face
- pacing
- fidgeting or twisting of hands clenching and unclenching of fists
- speech changes - increased in rate and volume, slowed, or silence
- making increased demands
what does anger look like:
- irritability
- frowning or grimacing
- red face
- pacing
- fidgeting or twisting of hands clenching and unclenching of fists
- speech changes - increased in rate and volume, slowed, or silence
- making increased demands
staff self-assessment
- nurses must be self-aware of strengths, needs, concerns, and vulnerability
- if not nursing interventions may be impulsive or emotion based
- nurse must be aware of words, tone of voice, non-verbal communication (body posture and facial expression)
staff safety
- avoid dangle items
- know layout
- stand to the side of pt and encourage pt to sit
staff self-assessment
- nurses must be self-aware of strengths, needs, concerns, and vulnerability
- if not nursing interventions may be impulsive or emotion based
- nurse must be aware of words, tone of voice, non-verbal communication (body posture and facial expression)
staff safety
- avoid dangle items
- know layout
- stand to the side of pt and encourage pt to sit
milieu consists of:
- containment – provision of basic needs, food shelter, safety and security
- support – offer encouragement, praise, and positive feedback
- validation – respecting privacy, cultural needs, feelings lead to the clients holistic health
- structure – control and limitation of maladaptive behaviors and setting limits
- involvement – promoting the self efficacy of the client
milieu consists of:
- containment – provision of basic needs, food shelter, safety and security
- support – offer encouragement, praise, and positive feedback
- validation – respecting privacy, cultural needs, feelings lead to the clients holistic health
- structure – control and limitation of maladaptive behaviors and setting limits
- involvement – promoting the self efficacy of the client
– difficulty controlling fine and gross motor movements
- Apraxia – difficulty controlling fine and gross motor movements
continuum of mental health and mental illness
good mental health and well being
- occasional stress to ______ distress
- ____ impairment
mental health problems – emotional problems or concerns
- mild to _______ distress
- mild or ________ impairment
mental health problems – mental illness
- ________ distress
- moderate to ________ impairment or chronic impairment
continuum of mental health and mental illness
good mental health and well being
- occasional stress to mild distress
- no impairment
mental health problems – emotional problems or concerns
- mild to moderate distress
- mild or temporary impairment
mental health problems – mental illness
- marked distress
- moderate to disabling impairment or chronic impairment
Fighting Stigma
- Talk openly
- Educate self and others
- Be conscious of language
- Show empathy and compassion
- Stop the criminalization
- Push back against the way mental illness is portrayed
- Advocate for mental health reform
- Encourage equality in physical and mental illness
- See the person not the illness
Fighting Stigma
- Talk openly
- Educate self and others
- Be conscious of language
- Show empathy and compassion
- Stop the criminalization
- Push back against the way mental illness is portrayed
- Advocate for mental health reform
- Encourage equality in physical and mental illness
- See the person not the illness
Neurotransmitters
______________
- Mood
- Emotion
- Sleep
- Pain
- Appetite
- Temperature regulation
- Some cognitive function
serotonin: inhibitory/calming
- Mood
- Emotion
- Sleep
- Pain
- Appetite
- Temperature regulation
- Some cognitive function
Decreased serotonin = depressive and anxiety disorders
